Frequency, pattern, and risk factors of postoperative recurrence of Crohn's disease after resection different from ileo-colonic.
BACKGROUND
The frequency of recurrence in Crohn's disease (CD) patients after curative resection different from the ileo-colonic is undefined. We aimed to assess the frequency, pattern, outcome, and risk factors of postoperative recurrence in CD patients under regular follow-up after anastomosis different from ileo-colonic.


METHODS
In a retrospective study, clinical records of 537 CD patients under regular follow-up from January 2001 to August 2007 were reviewed. The outcome after surgery was assessed on the basis of clinical records prospectively recorded.


RESULTS
Previous resection was observed in 183 of 537 (34%) patients, including the ileo-colon in 145 (79%) and other gastrointestinal (GI) segments in 38 (21%). Recurrence was detected in 16 of 38 (42%) patients (all symptomatic) including five of 14 (35%) with ileostomy, five of five (100%) with ileo-rectal, three of 11 (27%) with ileo-ileal, one or four (25%) with colorectal, and two of three (33%) with duodenum-jejunal anastomosis. Ileo-colonic resection was reported in 145 of 183 (79%) patients, showing recurrence in 128 (88.3%) and symptomatic in 47 (36.7%) patients. The frequency of recurrence was higher in patients with ileo-colonic resection than in patients with other types of resection (128/145, 88% vs 16/38, 42%, p < 0.001). The frequency of symptomatic recurrence was lower in patients with ileo-colonic resection than in those with other resections (47/128, 37% vs 16/16, 100%; p < 0.001). Risk factors for recurrence were comparable in the two subgroups (smoke, odds ratio, OR 1.5 vs 1.4; appendectomy, OR 0.32 vs 0.33; familial inflammatory bowel disease, OR 0.43 vs 1.26).


CONCLUSIONS
Postoperative recurrence is observed in a high proportion of CD patients after resection different from ileo-colon (including ileostomy), although at a lower frequency than observed after ileo-colonic resection.
Onali
Sara
S
Cattedra di Gastroenterologia, Dipartimento di Medicina Interna, Università Tor Vergata di Roma, Via Montepellier, 1 00133 Rome, Italy.
Petruzziello
Carmelina
C
Calabrese
Emma
E
Condino
Giovanna
G
Zorzi
Francesca
F
Sica
Giuseppe Sigismondo
GS
Pallone
Francesco
F
Biancone
Livia
L
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy; D003424:Crohn Disease / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D004724:Endoscopy; D005260:Female; D006801:Humans; D007081:Ileostomy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult